need help to this persistent high sugar at night.
my son is turning six this month. His sugar at night shoot up to over 16 every night regardless how much insulin we gave him. He is taking NPH during the day and at night, the insulin works during the day. His sugar is good at lunch and afternoon. We are not sure what caused this consistent high.
Anyone experienced somehting like that? what should we do?
thanks
Christine
Hi Christine,
It is possible your son is experiencing the "Dawn Phenomenon" where his sugars go up overnight (I am not sure what time his sugars are high in the night so not sure this applies)?
Do you mean his sugars are high at dinner or after dinner or overnight?
Unfortunately, NPH is not the best insulin (sorry, but this is what I was told and experienced and we went off of NPH and switched to Humalog for meals and Lantus at bedtime) since it is slow acting and unpredictable.
Since switching to fast acting insulin at meals I do have to bring my son home at lunch for a shot.
If this does not work for you, my son was on Humulin N (similar to NPH in how it reacts) in the a.m with humalog as well so he was on 2 shots at breakfast. The Humulin N covered his lunch and then we gave him humalog again at dinner and Lantus a bedtime.
Hope this is not too confusing but when all is said and done, I assume he takes NPH at supper and then no bedtime shot? This is a bit old school and my father and brother were on this routine and actually had a lot of nightime lows and as soon as Lantus (or Levemir) was released they switched and now have no issues.
Because the NPH is very slow acting, it will likely not have any immediate affect on supper or post supper blood sugars since it has not peaked. Is your doctor and/or you open to trying another routine.
Your son should really be on fast acting insulins for meals as this works best.
Hope I don't sound preachy but I have been where you are and the change in routine worked for us. Our biggest issue were high blood sugars after lunch so when we switched to Humalog at lunch my son has beautiful blood sugars mid-day after school and can have a snack and still be good at dinner.
Good luck...let me know what happens.
Jodi
Speak to his doctor. Our son, who just turned 12, went through a period of similarly the same thing a few months ago. He was perfect throughout the day and no matter how low he was before bed, or how little snack we gave him, he would wake up with a b/s reading of over 300. His nurses described it as a "dawn phenomenon," which was basically a fancy way of saying growth spurt. He takes Humalog during the day and Lantus at night. We had to make SEVERAL changes to his Lantus in order to get his numbers regulated which, because each change couldn't be made for 3 days, took over 1-1/2 months. As I mentioned, he is also 12 so there were probably more hormones involved with him than your son is going through.
Hi Christine (and Mrs. Smith),
The "dawn phenomenon" is not really a growth spurt per say but it is due to hormones. I am also a Type 1 diabetic (and my son, dad and brother) and also have the "Dawn Phenomenon". This can happen when hormones or cortisol levels rise in the early morning causing an increase in blood sugar. I am on an insulin pump and from 4am until 8am my basal rate for my insulin is almost DOUBLE due to the dawn phenomenon. The "dawn phenomenon" is not necessarily something a child will grow out of once they pass puberty; it is a common occurrence in Type 1 diabetics.
My son can have a blood sugar of 8.0 at midnite and when I check him at 3am he is still under 10.0 yet but 8am when we check his blood sugar he went up to 14.0-18.0. His endocrinologist said without an insulin pump, it is very hard to deal with the "Dawn phenomenon".
Good luck!!!
Hi Jodi
His sugar is high overnight. We check him at 1am in the morninig. For the last one and half years, the routine worked for him, his sugar usually before 4-6 in the morning. For the past few days, when we checked him at 1am, his sugar was high over 16 and woke up at 10 in the morning. We have increased his insulin double the amount, it still ended up the same results.
Not sure why just happened all the suddent?
Thanks
Your problem is very common and you've gotten some good advice.
Definitely check with his doctor if your son's blood sugar is elevated like that for several nights in a row. It would also be helpful if you could wake up 2 nights in a row to test blood sugar at midnight and 3am to help identify the problem.
To clarify a few things:
1) Insulin timing - like others have mentioned it's tough to time long acting insulin like NPH overnight; I wasn't able to have consistently good morning blood sugars until I used a pump because it better mimics how a pancreas releases insulin
2) Dawn phenomenon - often happens to diabetics in their teens, but can occur at any age; it's common in non-diabetic adults too and is thought to be the body's way of preparing to wake up because the liver releases glucose in the early morning hours and raises blood sugar
3) Low recovery - the base rate of insulin needed from 9pm to 2pm is often lowest at this time, so your son could have a middle of the night low the body fights by releasing glucose from liver, causing a severe high in morning
4) Growth spurt - best indicator is if your child is also eating & sleeping more, increase insulin temporarily but be cautious of lows when hormones return to normal and insulin isn't inhibited
5) Illness - even just fighting off a cold can inhibit insulin just like a growth spurt
6) High carb or high fat dinner - digestion is slower in the evenings and high fat/carb meals take longer to digest and don't hit blood sugar until hours later; high fat and high carb meals also often require more insulin than the carb count indicates
I've seen others write that managing blood sugars is an art, not a science. So true! Start by talking to your son's doctor and then it usually takes trial and error to figure out how to manage the problem.
Blood sugar and insulin needs are ALWAYS changing. That's why people with type 1 tend to be quick and creative problem solvers.
Take care. -Jenna
hi Jenna
my son has have very good readings in the morning between 4-6 for the past one and half years even he is on NPH.
He was not low at 1am in the morning instead he was very high during that time, so not sure the Dawn phenomenon applies.
We incresed NPH and also gave him extra Humanlog when we found out he was high. Regardless how much the insulin we gave him, he still ended up waking up at 9 in the morning.
The only things left on your list are the Growth spurt and illiness. He did not show any signs of being sick. It maybe the growth spurt. If it is the case, it should clear up in around three days, so far, it has been three days now. Anything I can think of just did not apply here.
Still not sure what to do...
Thanks for the advices!
We've only been doing this for about 1.5 years so I'm not as familiar with it as Jenna, but I can tell you from my experiences dealing with my own son that there is no easy answer. As Jenna mentioned his dinner could be a factor and I wouldn't rule out some sort of mild illness. My son has seen higher readings with showing no symptoms then all of a sudden start sniffling, and as soon as his illness went away his readings regulated.
I don't know if it would help, but what we've been doing is keeping a journal of everything our son eats, what goes on in his day and any changes to routine, medication, etc. It was originally started when he was dx just to help us see how certain foods affected him, but it became a habit we just haven't gotten out of. I wouldn't suggest you do this permanently but it would definitely help you and your doctor come up with a solution to the problem.
I wish you luck. Let us know how it turns out.
If his blood sugars are still high then he needs more insulin.
You may also ask the doctor if it would help to take the evening NPH at a different time or to try Lantus. The disadvantage with Lantus is you can't take it in the same syringe as short acting insulin.
Increasing insulin is a normal part of growing up. When I was a kid I took 5 units of insulin a day. As a middle aged adult I now take closer to 50 units. Sometimes is was a gradual change and other times it would be a dramatic increase.
Let us know what changes ultimately help solve the problem. It sounds like you're doing a really good job.
Thanks for everyone's inputs!
His sugar was high again overnight even after the swimming. We did keep a journal of everything he eats and activities he does. There were not anything different than what we usually did in the past 1.5 years since he was diagnosed.
The only scarely part of it is we have increased double and triple amount the insulin than we usually gave him in the same situation like that. It seems like not working. We are just very afraid to increase further more in case his body reacts differently and drop low overnight.
We will keep you posted as it goes.
Thanks!
Hi Christine,
Just a quick note that you should always wait a few days when making changes to your sons insulin to make sure the dose is not working. My doctor has a 3 day rule (try new dose for 3 days) before making more changes.
Also, apparently I am told that swimming as it uses the large thigh muscles can actually shoot sugars up and then later (possible today) you may notice they are lower.
As well, do you rotate the site of his injections?
If all else fails, it could be a growth spurt. It is good that you are keeping a journal for his food, activites and doses. I normally do this for my son and it gives us an idea of any issues.
I know it is frustrating as I can tell you my sugars have been doing better in the a.m. when I wake up but the last few days they have been very high at 19.9. I changed my infusion site and still no change and there is nothing new or different so I am very frustrated.
Good luck!!!
Hi Jodi
Thanks for sharing your thoughts and feelings!
We did rotate his injection site. We started using his belly as he allows us now few last week ago.
He was high at 12.8 last night and we gave him Humanlog 0.5, his sugar was 5.8 this morning. So you maybe right about the growth spurt. We will see tonight how it goes.
I hope you find your reasons why you were high in the morning soon as it is very frustrated.
I will keep you posted!
thanks again!
just a quick update
my son's sugar is finally gone down for the past two days. So I guess it was probably the growth spurt.
Thanks everyone!
I have to agree Jodi when my son was on shots his bs was all over the place high & low, I was glad when he finally went on the pump Dec 2012 but then I wasn't really noticing any difference but he has grown alot in the last 6 months and I realize it is gonna just take time for them to get his settings where they need to be and his doctor just increased his basals : he now has 3 different rates and he gets more between midnight and 7 am to help with his morning highs and it has helped. And I just try to remind myself that Diabetes is not perfect and he will probably not have real good numbers until he stops growing. He is only 10 and he is 4 ft 11 1/2 inches tall and growing!!(lol)
I have to agree Jodi when my son was on shots his bs was all over the place high & low, I was glad when he finally went on the pump Dec 2012 but then I wasn't really noticing any difference but he has grown alot in the last 6 months and I realize it is gonna just take time for them to get his settings where they need to be and his doctor just increased his basals : he now has 3 different rates and he gets more between midnight and 7 am to help with his morning highs and it has helped. And I just try to remind myself that Diabetes is not perfect and he will probably not have real good numbers until he stops growing. He is only 10 and he is 4 ft 11 1/2 inches tall and growing!!(lol)